Aesthetic rehabilitation of full mouth

A 20 yr old female patient visited Denty’s Kakinada with a chief complaint of pain in upper front teeth. Patient had deep caries in multiple teeth 13, 22, 23, 24, 26, 31, 32, 33, 36, 41, 42, 43, 44, 45, 46, a few grossly decayed teeth 27, 21, 11, 12, brittle enamel, xerostomia (dry mouth) and a palatally impacted tooth irt 25. She gave a history of consanguineous marriage.

An interdisciplinary approach using different fields of dentistry (endodontics, prosthodontics and omfs) was planned to relieve the patient from pain and gain maximum results for a full mouth rehab giving her an aesthetic smile.

Pre Treatment

Keeping patients dental and general health in mind the treatment plan included root canal treatment irt 13, 22, 23, 24, 26, 31, 32, 33, 36, 41, 42, 43, 44, 45, 46 extraction irt 27,21,11,12, followed by post and core and composite build up irt 13,22,45,46 . Temporization of teeth was also planned to increase the vertical dimension followed by PFM crowns irt 11 to 17, 21 to 27, 31 to 37 and 41 to 47.

Treatment started as planned, 11,12,21,27 extractions followed by root canal treatments for 13, 22, 23, 24, 26, 31, 32, 33, 36, 41, 42, 43, 44, 45, 46. Metal posts were placed and composite core build ups were done irt 46; Fibre posts and composite build up was done irt 13, 22, 45 for better strength. Post RCT, crown preparations were done carefully to prevent pulp exposures and 2 stage polyether impressions were made. Vertical dimension was corrected by LUCIA’S JIG. Temporary crowns were luted for 3 weeks for the patient to adjust with the increased vertical dimension and mean while metal and bisque trials were done whenever required for the PFMS. Extraction of the palatally impacted tooth was avoided due to patient’s anemic condition and the bridge in the 2nd quadrant was luted with temporary cement so that it could be removed whenever needed.

One of the most significant challenges for doctors was to convince the patient for the treatment as this patient has very low I.Q and inability to speak fluently. Our team also faced difficulty in motivating the patient on maintaining good oral hygiene.

This case emphasizes that to achieve the aesthetic result a multidisciplinary approach is necessary. Our teams could provide functional and aesthetic restorations to the patient.

Doctors
Dr. Krishna Mohan, Endodontist
Dr. Narayana Reddy, Endodontist
Dr. Vikram Kumar, Prosthodontist
Dr. Neelima, General Dentist
Dr. Geetanjali, General Dentist
Dr. Aswani, General Dentist

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